• An intervention that uses the principles of psychology to try to improve the life of a person who is unhappy or disturbed.

Goals

• Diagnosis
• Identifying etiology
• Determining prognosis
• Treatment

Types of Therapists

• Counseling psychologist (PhD)
• Clinical social worker (LCSW)
• Pastoral counselor
• Clinical psychologist (PhD or PsyD)
• Psychiatrist (MD)
• Psychoanalyst (typically MD or PhD)

Major Types of Psychotherapy

• "Talk" Therapies
• Psychodynamic
• Humanistic/existential
• Behavioral
• Cognitive
• Biomedical Therapy

Psychodynamic

• Emphasizes insight..
• Patient improves by confronting unconscious "repressed" feelings, motives, and memories.
• Major tools are free association and dream interpretation.

Humanistic/Existential

• Most psychological problems result from incongruence between the self-concept and the ideal self.
• Goal is to allow the client to discover his or her problems and to make choices to correct them.
• Nondirective.

Behavior Therapy

• Based on principles of classical and instrumental conditioning.
• Unique features:
• Short-term
• Seeks intervention to alleviate symptoms
• Extremely directive
• Concentrates on behavior, not causes.

Cognitive Therapy

• People change their behavior by changing their thoughts.
• Ellis's rational-emotive behavior therapy:
• Confrontational; therapist attacks rationality of client's beliefs.
• Beck's cognitive therapy:
• Tutorial

How Common Are They?

• In a survey of 415 clinical psychologists, 41% identified themselves as "eclectic."
• Next most common was psychodynamic (14%).

Effectiveness of Talk Therapies

• Psychotherapy works and its effects can be long-lasting.
• Behavioral therapies are particularly effective for treating anxiety disorders (e.g., phobias).
• Cognitive therapies are particularly effective for treating depression.

Effectiveness of Talk Therapies

• However, by and large, there is little difference between therapies in their effectiveness.
• What matters most is the therapist-client alliance.

Effectiveness of Psychotherapy

• Characteristics of successful therapists:
• Warm involvement with client.
• Ability to communicate a new perspective on the client's situation.
• Characteristics of successful clients:
• Desire to improve and a belief in the efficacy of therapy.
• Self-disclosing communication.

Biomedical Therapy

• Antipsychotic drugs
• Used to treat schizophrenia.
• Affect the processing of dopamine.
• Most common are phenothiazenes (e.g., chlorpromazine, haloperidol).
• May have severe side effects.
• Not a cure.

Biomedical Therapy

• Antidepressant drugs
• Monoamine oxidase (MAO) inhibitors (e.g., Marplan, Nardil)
  • Elevates levels of serotonin & norepinephrine by blocking enzyme that deactivates them.

Antidepressant drugs continued . . .

• Tricyclics (e.g., Tofranil, Elavil)
  • Blocks reuptake of serotonin & norepinephrine.
• Selective serotonin reuptake inhibitors (SSRIs)
  • Fluoxetine (Prozac)

Biomedical Therapy

• Antidepressant drugs
• May have unpleasant side effects, e.g., dry mouth, headache, gastrointestinal problems, decreased sexual desire and blocked orgasm.

Biomedical Therapy

• Antianxiety drugs
• Alleviate tension and anxiety.
• Benzodiazepines (Librium, Valium)
  • increases activity of GABA
• Lithium
• Effective for bipolar disorder.

Biomedical Therapy

• Biomedial therapies are more effective when combined with talk therapy.
• Depression
  • Cognitive-behavioral therapy
• Bipolar disorder
  • Personal & family therapy
• Schizophrenia
  • Social-skills training

"Family-focused treatment"

• Education about symptoms, nature, causes, and treatment of bipolar disorder.
• Patients and relatives learn communication skills; e.g., active listening, requesting changes in behavior, giving positive and negative feedback.
• Learning to generate solutions to problems in day-to-day life.

Summary

• Talk therapies are effective, but most of the variance in treatment outcomes is explained by the therapist-client relationship, not the therapy.
• Biomedical therapies are essential for severe disorders, e.g., schizophrenia & bipolar disorder, and are better when combined with talk therapy.